Fever and Seizure in an 11-month old Girl.

Abstract

1. Avani Ganta, MBBS* 2. Adin Nelson, MD* 3. Carol Singer-Granick, MD* 4. Aditi Khokhar, MBBS* 1. *Rutgers New Jersey Medical School, Newark, NJ An 11-month-old Black girl, born at term, with no significant medical history presents to the emergency department (ED) after becoming unresponsive at home. She had 2 days of nasal congestion, rhinorrhea, and tactile fever. She had an episode of upward eye rolling and stiffening of the upper extremities, followed by unresponsiveness at home. The whole episode lasted for approximately 2 minutes. Her parents started cardiopulmonary resuscitation on her and called emergency medical services (EMS). On EMS arrival, the patient was responsive but weak. In the ED she is febrile to 103°F (39.4°C), tachycardic with a heart rate of 161 beats/min, alert, and active. Her blood pressure is initially high at 116/76 mm Hg, but it normalizes to 91/67 mm Hg on admission. Her physical examination findings are normal except for nasal discharge. Auscultation yields normal S1 and S2 heart sounds with no murmurs, and lung fields are clear. Abdominal examination findings are normal, with no distention or organomegaly. Neurologic examination findings are normal for her age: the patient is smiling and playful. Her pupils are equal and reactive bilaterally. No facial asymmetry is noted. She has good strength in all extremities, is sitting without support, and can pull to stand. She has symmetrical normal reflexes and a negative Chvostek sign, and no fasciculations or spasms are noted. She had no frontal bossing, widening of wrist joints, or long bone deformities. Laboratory studies are obtained, including complete blood cell count, complete metabolic panel, urinalysis, blood culture, and urine culture (Table). Initial laboratory evaluation shows a hemoglobin level of 12.9 g/dL (129 g/L); hematocrit value, 38.2%; white blood cell count, …